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To people who grew up before the internet, the debate about whether Craigslist should be allowed to post “erotic services” must seem bizarre. But meeting people online, whether for romance, friendship, collegiality, or anonymous sex is becoming not only common, but has lost its novelty. This isn’t going anywhere. The most compelling argument I’ve heard for asking Craigslist to abandon its lucrative paid sex ads is that it helps perpetuate an oppressive and violent sex trade, one that essentially enslaves women and turns them into chattel for the profit of others. That’s pretty damned compelling.

But should those of us who care about public health focus only on the "sex work” section of online bulletin boards? People meeting not only for romance but also for consensual, sometimes anonymous sex has become increasingly common. Like the bath houses of the 1970s, could online sex encounters encourage the risk of sexually transmitted infections?

Data from before the late 1990s are hard to find, since broadband internet services were not widely available. In 2000, a study of a small syphilis outbreak among men who have sex with men (MSM) found that the men who had syphilis were much more likely to have met partners in an online chat room than men without syphilis. This made notification of contacts (for control of the outbreak) more difficult. Of note, when public health authorities launched an informational campaign about the phenomenon, gay online chat rooms were flooded with anti-gay hate messages, perhaps interfering with effective outreach.

Since that initial report, further studies seemed to confirm that meeting sex partners online conferred an increased risk for sexually transmitted diseases, especially among men who have sex with men. A more recent study from the journal Sexually Transmitted Infections aimed to clarify this risk.

The authors combed the records of a sexual health clinic in Denver for patients with a history of chlamydia or gonorrhea confirmed by laboratory testing. They then looked for a history of having sex with someone met online (this was a question asked of all the patients). Neither the group with these infections nor those without were more likely to have met sex partners online, arguing against what has become common knowledge. Earlier data suggested any effect might be more prominent among MSM, but while they found MSM to be significantly more likely to find sex partners online, there was no significant difference in infection rates between MSM and other groups.

The authors discuss possible weaknesses of this study, but there a few critical problems left undiscussed. Chlamydia and gonorrhea are not terribly rare in men who have sex with men, but left out were syphilis, HIV, and HPV infections. These infections have been implicated in earlier reports of online sexual behavior. While it is encouraging that sexual encounters that originate online may not be a unique risk factor for gonorrhea and chlamydia, these other diseases can be pretty devastating.

Ten years ago, not many Americans had internet access, and even fewer had broadband access. Human ingenuity inserted sex into online interactions early, and increasing penetrance of the internet into our lives may increase the frequency of risky sexual encounters. In And the Band Played On, journalist Randy Shilts reported the difficult work of teasing out the origins of the AIDS pandemic, including the sociopolitical challenges of telling a despised minority that some of their behaviors were risky. Studies like the one one on chlamydia and gonorrhea will hopefully help flesh out the interaction between internet hook-ups and health risks so that we can better target at risk groups for preventative education.